The incidence of pancreatic cancer in India is estimated to be 2.5–3.5 per 100,000 people, compared to 10–15 per 100,000 people in Western countries. The absolute number of cases is still significant in India with an estimated 35,000 to 40,000 new cases per year, with an annual spike of 2-3%.
Though this incidence is much less in India than Western countries, it is still a cause of concern because of the high morbidity and mortality associated with this deadly disease. This was said by doctors of Sammprada Hospital, Bengaluru, during the ongoing Pancreatic Cancer Awareness Month.
Said Dr. Radheshyam Naik, Consultant Medical Oncologist, Hematologist and Bone Marrow Transplant Physician at Sammprada Hospital, Bengaluru: “Pancreatic cancer is 4th or 5th most common cause of cancer mortality.
It has very poor prognosis, with high mortality. Morbidity, such as pain in the abdomen, jaundice, mal-absorption, depression and muscle loss, is common. The five-year survival rate of patients is merely 9%, which means that 91% of all pancreatic cancer patients are expected to die within 5 years.
The one-year survival rate is 29%, meaning that 71% of deaths in pancreatic cancer occur in one-year time frame.”The incidence of pancreatic cancer is increasing in India over the years, the doctor said.
“The increase can be attributed to lifestyle factors such as rising rates of obesity, smoking, and alcohol use. Smoking is the single most significant modifiable risk factor for pancreatic cancer.
Additionally, high-fat diets, obesity, and diabetes are also contributing factors. The growing prevalence of diabetes in India, which is linked to an increased risk of pancreatic cancer, may influence future trends,” he added.
Talking about treatment, Dr. Radheshyam Naik said that surgery, radiation, chemotherapy and biological therapy are the main options. He added: “Interestingly, 20 years ago, lung cancer and pancreatic cancer had similar prognosis and cure rates.
New developments in lung cancer care have transformed the picture and many of the advanced lung cancer patients are living for more than 5 years, while most of the lung cancer patients live for at least 2-3 years.
However, research in pancreatic cancer over the years has not yielded much benefit, with around 70% of the pancreatic cancer patients still dying within 1 year. There are many reasons for this. Pancreas is an organ is very deeply embedded in the human body.
It can grow to a large size and metastasise by the time it gets diagnosed. Biologically, it has a very aggressive behaviour and stage-to-stage, pancreatic cancer is worse than most other cancers. Also, clinical features of pancreatic cancer are very vague, non-specific and can be easily missed unless an imaging scan has been done.”
He doctor said: “Immunotherapy, specially the immune checkpoint inhibitors as a group of drugs, has changed the prognosis of many types of cancers including lung cancer, colon cancer, stomach cancer, renal and hepatic cancers.
Unfortunately, these drugs have not made any meaningful impact on pancreatic cancer for some reason.”Recounting the main challenges in treatment, Dr. Vinod K Ramani, Preventive Oncologist at Sammprada Hospital, Bengaluru, said that first and foremost, most of the pancreatic cancers are not operable.
Secondly, even when they are operable, surgery is very complex and can lead to post-operative complications. Even after complete surgery, many of the patients recur. “Most of pancreatic cancers have only chemotherapy as their main treatment.
Most of these patients have many types of co-morbidities and habits like smoking and alcohol. Their tolerance to chemotherapy is poor. In addition, the malnutrition associated with pancreatic cancer comes in the way of effective treatment.
Radiation is less effective than surgery in pancreatic cancer. It is done when surgery is not possible or after surgery as an adjuvant treatment. Unfortunately, other biological therapies like bevacizumab and targeted agents have not worked well in case of pancreatic cancer,” the doctor added.